Doula Integration Toolkit // Integration Approaches
Integration Approaches
Integration approaches will vary based on the unique circumstances of each care team and setting. To start off, facilities and providers looking to integrate doulas should first look to existing doula organizations, groups, and independent providers in their area. Instead of building a doula strategy or service line from scratch look to engage doulas in your community and explore what approach will best serve your area.
Use the resources in this section to understand the various options and considerations related to doula integration.
Creating a Collaborative Birth Team Environment
New York State Department of Health:
Doula Pilot Program: Findings from Focus Groups of Doulas and Clients in Buffalo
Provides a number of recommendations for enhanced operations of doula organization including provider and hospital referral and education recommendations.
Louisiana Public Health Institute:
Doula Coordination Community of Practice Project Report
Describes the framework and outcomes of a community of practice to enhance doula integration into the hospital setting in Louisiana.
Birth:
Hospital-based Maternity Care Practitioners Perceptions of Doulas
Interview results from medical team members at three hospitals on their attitudes towards doulas and strategies to enhance integration of doulas into the care team.
Journal of Obstetric, Gynecologic, and Neonatal Nursing:
Nurses and Doulas: Complementary Roles to Provide Optimal Maternity Care
Defines doula role and offers suggestions for nurse/doula collaboration.
Missouri PQC:
Defines the doula role and provides overview of the benefits of doula care. See pages 16-17: creating a collaborative birth team environment.
Best Practices for Implementing Doula Friendliness and Action Plan Template
New York City Health and Hospitals:
NYC Hospital Doula-Friendliness Guidebook
Provides a myriad of resources for hospitals specific to doula integration including:
Hospital Doula Friendliness Process Map p.8
Doula Friendliness Process Optimization p.9-10
Doula Friendliness Action Plan p.19-20
Hospital Doula Policy Design p.21-27
Best Practices for Implementing Doula Friendliness p.28-29
Sample Doula Policy p.49-50
Letter to Colleagues on Doula Support p.51
Maternity Hospital Quality Improvement Network overview and lessons learned related to doula integration p. 30-35
The Doula Friendly Initiative:
What is Doula Friendly Initiative?
Can assist with doula friendly designation, including doula friendliness assessment, a development plan, and doula integration resources.
California Maternal Quality Care Collaborative:
Toolkit to Support Vaginal Birth and Reduce Primary Cesareans
This resource from the CMQCC includes Administrative Strategies, Clinical Strategies, and Educational Strategies for integrating doulas into the Birth Care Team. The toolkit also contains information on the importance of doulas in promoting primary vaginal deliveries and reducing cesarean sections.
Key Strategies, page 19
Team-Based Care, page 84-85
System-wide Integration, pages 86-87
Strategies for Integrating Doulas into the Birth Care Team
Primary Maternity Care:
Partnership and Referral Workflow for Doula Services Integration
Integration steps focused on practices seeking to contract with doulas.
Women’s Health:
Outlines doula integration strategies based on interviews with a variety of stakeholders involved in existing integrated doula programs.
Journal of Midwifery and Womens Health:
A Qualitative Study of Hospitals and Payers Implementing Community Doula Support
Study resulting in three core recommendations when implementing integrated doula programs
Healthy Mothers, Healthy Babies Coalition of Georgia:
Background and results of doula pilot program in Georgia
Journal of Midwifery and Women’s Health:
Outlines a model called the Champion Dyad Initiative for healthcare facilities and community based doula program integration rooted in the experiences of a community based doula group and 5 clinical sites in California
Primary Maternity Care:
Health Leads:
Redesigning Maternal Health: Integrating Doulas into Care Teams
Webinar that reviews doula integration resources and lessons learned from New York, Louisiana, and Massachusetts communities of practice.
California Maternal Quality Care Collaborative:
Partnering with Doulas to Improve Perinatal Outcomes and Promote Birth Equity
PowerPoint deck and companion webinar, slides 30-32 provides key strategies for how to partner with doulas.
Health Affairs Scholar:
Building HOPE: Integrating Community-Based Doula Care in Public Hospitals in New York City
Program in New York City hospitals centering the needs of the community to inform doula integration into clinical care teams, including adjacent issues such as workforce development and reimbursement.
Examples of Hospital Doula Policies and Integration Programs
Health Leads:
Redesigning Maternal Health: Integrating Doulas into Care Teams Webinar Deck 2025
Webinar that reviews doula integration resources and lessons learned from New York, Louisiana, and Massachusetts communities of practice.
California Maternal Quality Care Collaborative:
Toolkit to Support Vaginal Birth and Reduce Primary Cesareans
This resource from the CMQCC includes two example hospital doula integration programs on page 104.
Connecticut HUSKY Health:
Hospital or Provider Doula Policy
This Document outlines and clarifies the role of doulas. It also highlights best practices and how hospitals and provider practices can include doulas as part of the care team to best support HUSKY Health Members.
New Jersey Health Care Quality Institute:
Guide for Hospital Doula Policy Creation
Provides best practices for hospital doula policies.
Journal of Health Care for the Poor and Underserved:
The Birth Sisters Program: A Model of Hospital-Based Doula Support to Promote Health Equity
Describes the long-standing Birth Sisters doula program provided at Boston Medical Center.
Health Equity:
Results from the Birth Sisters employed doula program at Boston Medical Center.
The Burke Foundation:
St. Joseph’s Health bets on doulas - and sees early results
Description of fully employed doula program at a hospital in New Jersey
New Jersey Health Care Quality Institute:
Presentation Deck for the Guide for Hospital Doula Policy Creation
Provides quick reference point on guiding principles for hospital policies and practices on doulas including policy implementation, external distribution, hospital access, the role of doula liaison, and additional best practices.
New York City Health:
City supported website offering background and resources for doula access geared towards a wide audience of patients, birthing facilities, and clinical providers.
National Health Law Program:
California Doula Pilots Lessons Learned
A series of resources providing a summary, challenges, and lessons learned from 10 different doula pilot programs in CA
Health Connect One:
Aims to assist hospitals in integrating doulas into their maternity care through assessment of hospital readiness, development of a custom action plan, dissemination, and accreditation.
Integrating Doulas into Patient Safety
Primary Maternity Care:
Coming Soon! Integrating Doulas in Community Birth Transfers
Blog post from the team behind Step Up Together describing the doula role in clinical emergencies specific to community birth transfer
Primary Maternity Care:
Coming Soon! The Role of Doulas in Clinical Emergencies
Resource from the team behind Step Up Together describing the doula role in clinical emergencies including community birth transfers